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Microorganisms
Volume 13
Issue 2
10.3390/microorganisms13020328
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Background:
Systematic Review

Post-COVID-19 Small Fiber Neuropathy as a New Emerging Quality of Life-Threatening Disease: A Systematic Review

by
Francesca Bandinelli
1,*,
Marco Di Carlo
2,
Virginia Alba Colantuono
3,
Filippo Nozzoli
4,
Fausto Salaffi
2,
Barbara Chiocchetti
5,
Elena Nucci
6,
Alessandra Mastricci
7,
Eleonora Gherardi
3 and
Mirko Manetti
8
1
Rheumatology Department, Santa Maria Nuova Hospital, Usl Tuscany Center, 50122 Florence, Italy
2
Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica of Marche, Carlo Urbani Hospital, Jesi, 60035 Ancona, Italy
3
Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy
4
Section of Pathological Anatomy, Department of Health Sciences, University of Florence, 50139 Florence, Italy
5
Neurology Department, San Giovanni di Dio Hospital, Usl Tuscany Center, 50143 Florence, Italy
6
Histopathology and Molecular Diagnostics, Careggi University Hospital, University of Florence, 50139 Florence, Italy
7
Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, 50139 Florence, Italy
8
Section of Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
*
Author to whom correspondence should be addressed.
Microorganisms 2025, 13(2), 328; https://doi.org/10.3390/microorganisms13020328
Submission received: 6 December 2024 / Revised: 23 January 2025 / Accepted: 31 January 2025 / Published: 2 February 2025
(This article belongs to the Special Issue Microbial Infections and Rheumatic Diseases)
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Abstract

Post-acute sequelae of COVID-19 (PASC) syndrome is considered an emergent and diffuse multidisciplinary problem. Compelling evidence suggests that COVID-19 increases symptoms of pre-existent small fiber neuropathy (SFN) and might trigger de novo onset of SFN. In this systematic review, for the first time, we provide a comprehensive overview of the clinical and diagnostic features of PASC-SFN, including the accompanying disorders, disease evolution, and possible treatments, described in the recent literature. Following infection, many patients reported a wide range of symptoms and complications, not self-limiting and independent from previous infection severity. SFN begins more frequently with distal limb burning pain and numbness, which accompany other dysautonomia, cognitive, visual, and osteoarticular disorders involving multiple organ systems. In an initial diagnostic suspicion, some tests might be useful as complementary examinations, such as nerve quantitative sensory testing, electromyography, and optic nerve tomography. Otherwise, definite diagnosis is reached with skin biopsy as the gold standard, along with corneal in vivo microscopy when ocular discomfort is present. Being a long-term condition, multiple and dissimilar symptomatic and disease-modifying drugs were employed for the treatment of this condition with the achievement of partial results, including steroids, pregabalin, gabapentin, duloxetine, vitamins, homotaurine and phosphatidylserine, alpha lipoic acid, immunosuppressants, and intravenous immunoglobulin therapy. PASC-SFN is a complex emerging disease and extremely challenging for physicians. At present, the only feasible management of PASC-SFN is represented by a multidisciplinary tailored approach, with future definitive protocols for diagnosis and treatment deemed essential.
Keywords: small fiber neuropathy; COVID-19; post-acute sequelae of COVID-19; arthritis small fiber neuropathy; COVID-19; post-acute sequelae of COVID-19; arthritis

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MDPI and ACS Style

Bandinelli, F.; Di Carlo, M.; Colantuono, V.A.; Nozzoli, F.; Salaffi, F.; Chiocchetti, B.; Nucci, E.; Mastricci, A.; Gherardi, E.; Manetti, M. Post-COVID-19 Small Fiber Neuropathy as a New Emerging Quality of Life-Threatening Disease: A Systematic Review. Microorganisms 2025, 13, 328. https://doi.org/10.3390/microorganisms13020328

AMA Style

Bandinelli F, Di Carlo M, Colantuono VA, Nozzoli F, Salaffi F, Chiocchetti B, Nucci E, Mastricci A, Gherardi E, Manetti M. Post-COVID-19 Small Fiber Neuropathy as a New Emerging Quality of Life-Threatening Disease: A Systematic Review. Microorganisms. 2025; 13(2):328. https://doi.org/10.3390/microorganisms13020328

Chicago/Turabian Style

Bandinelli, Francesca, Marco Di Carlo, Virginia Alba Colantuono, Filippo Nozzoli, Fausto Salaffi, Barbara Chiocchetti, Elena Nucci, Alessandra Mastricci, Eleonora Gherardi, and Mirko Manetti. 2025. "Post-COVID-19 Small Fiber Neuropathy as a New Emerging Quality of Life-Threatening Disease: A Systematic Review" Microorganisms 13, no. 2: 328. https://doi.org/10.3390/microorganisms13020328

APA Style

Bandinelli, F., Di Carlo, M., Colantuono, V. A., Nozzoli, F., Salaffi, F., Chiocchetti, B., Nucci, E., Mastricci, A., Gherardi, E., & Manetti, M. (2025). Post-COVID-19 Small Fiber Neuropathy as a New Emerging Quality of Life-Threatening Disease: A Systematic Review. Microorganisms, 13(2), 328. https://doi.org/10.3390/microorganisms13020328

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